The Real Death Panel

For a brief moment at the close of last year we were regrettably back to discussing ObamaCare’s fictionary “death panels”, the phrase Governor Sarah Palin coined to describe Medicare reimbursement of voluntary, end-of-life counseling.

After substantial outcry prevented the provision from being included in the health law, our rationer-in-chief, Center for Medicare and Medicaid Services Administrator Dr. Donald Berwick did an end-around the public and instituted it via regulation on December 3rd.

Thereupon, the false death panel charges reemerged in full force, until January 3rd, when the White House pulled the plug on the provision. No, not the plug on grandma---this time.

But don’t even think about releasing a big sigh of relief considering ObamaCare creates a very real death panel, the Independent Payment Advisory Board (IPAB) that will effectively pull the plug on countless grandparents. When leftists such as Peter Orzag and Ezra Klein describe IPAB as one of the law’s most important provisions, you know there is great reason to be scared.

IPAB’s 15-member panel of unelected, Senate-appointed bureaucrats is explicitly charged with making “recommendations to slow the growth in national health expenditures ... that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively." Specifically, starting in 2015 their recommendations have to keep Medicare spending below a hard annual, per-capita cap dictated by an inflationary formula.

Congress has the power to vet their recommendations, but the law’s authors intentionally made sure the vetting structure isn’t very potent. For example, if Congress sits idly, IPAB’s recommendations automatically go into effect. Even if both houses of Congress say no to the recommendations, the President still has the power to issue a veto that, if not overturned, will also allow them to automatically go into effect.

Thus, if pro-ObamaCare Democrats control either the Presidency or just one body of Congress, the recommendations are virtually guaranteed to go into effect. I guess elections really do have consequences.

A critic might respond that the IPAB’s recommendations won’t be terribly objectionable given that their members will have to be appointed on a bi-partisan basis to get through the Senate. In fact, it wouldn’t be a shock if the bi-partisan board can’t agree upon any recommendations as a result of its members’ vastly different governing philosophies.